From ethics of ignorance to consumers empowerment

Italian forum of Europa Donna: a survey of breast cancer associations

Europa Donna is the first European woman's movement against breast cancer. It is a coalition of breast cancer associations and individual women and is active in 20 nations. Europa Donna is not intended to replace existing organizations. Rather, it provides a focus for the exchange of information and experiences between members and serves as a moving force for combined action. It promotes public awareness of breast cancer, advances in research and good clinical practice. In Italy there are more than 200 active breast cancer associations. The Italian forum of Europa Donna was formed in 1996. Between June and September 1996 a postal survey was conducted to research the characteristics and activities of the various breast cancer associations in Italy in order to help, inform and promote future initiatives of the Italian forum of Europa Donna. A total of 213 breast cancer associations were sent a postal questionnaire. Ninety-five of them (44.6%) participated in the survey. The results show that the breast cancer associations in Italy vary markedly in terms of their structure and organization. The associations perceive a variety of deficiencies in the prevention, diagnosis and treatment of breast cancer within the Italian National Health Service and they offer a wide range of services themselves. Their views of the relevance of the 10 goals of Europa Donna vary. In this paper, we discuss the implications of the low rate of participation in the survey and the heterogeneity of the breast cancer associations' structures, activities and views for the future activities of the Italian forum of Europa Donna.

Promoting consumers' demand for evidence-based medicine

The widespread implementation of rationing and priority-setting policies in health care opposes the stochastic practice of medicine induced by professional uncertainty and professional vested interests in market-oriented clinical environments. It also clashes with consumers' overly optimistic and "mythical" view of the effectiveness of medicine, which is bound to support a potentially unlimited provision of health services. Thus, for consumers and society at large, it is necessary to create conditions favorable for a more conscious demand of evidence-based health care. In pursuit of this goal, we suggest the adoption of a community-oriented strategy based upon delivery of information to the public in order a) to generate greater awareness ("healthy skepticism") among consumers, through disclosure of data on the true effectiveness of health care interventions and on the existing variation in their utilization, and b) to provide tools to empower consumers in dealing better with both the uncertainty in their own individual patient-physician relationships and with the health policy issues to be faced in the future. Such a community-oriented strategy could also reinforce and support, through the generation of a "bottom-up" pressure from consumers toward physicians, a wider adoption of evidence-based interventions by health care professionals. This paper, using data from surveys on public opinions and attitudes toward the practice of medicine, focuses on how consumer demand for more evidence-based medical practice can be promoted.